Late-Presenting Myocardial Infarction With PCI and Impella Placement Complicated by Ventricular Septal Defect and Impella Malfunction.

Post-myocardial infarction ventricular septal defect (VSD) is a rare but frequently fatal mechanical complication. We report a 67-year-old man who presented approximately 48 hours after symptom onset with dyspnea and was diagnosed with an ST-segment elevation myocardial infarction. He underwent emergent percutaneous coronary intervention supported by Impella placement but subsequently developed a large ventricular septal defect two days later, complicated by Impella malfunction. The patient ultimately underwent successful surgical repair. This case highlights the importance of maintaining a high index of suspicion for mechanical complications in late-presenting myocardial infarction, even after apparent stabilization with revascularization and mechanical circulatory support.